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Diagnosing ADHD With The Help Of EEG

Publication date: 18 July 2013

This week the US Food and Drug Adminstration (FDA) approved an EEG assessment system for the assessment of Attention Deficit Hyperactivity Disorder or ADHD in children. This is an interesting and welcome development, but only a small step in changing how the medical establishment assesses and diagnoses mental and neurological health. ADHD is traditionally diagnosed (as are all mental illnesses) according to behavioural symptoms. I think a much more useful approach is to look for underlying causal factors, as it opens the way to a more rational choice of therapy.

An ADHD diagnosis does not entail a presumption of a brain deficit. (See for example the NICE guidelines on diagnosis and management of ADHD.) You're likely to be referred to a psychiatrist. There are three sub-types of ADHD - characterised by (i) inattentiveness, (ii) hyperactivity and impusivity, and (iii) a combination of these two.

The new system is called the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System. The assessment takes about 15-20 minutes and measures the ratio of two EEG or brainwave frequency bands, theta and beta. Actually it's been known that theta to beta ratio correlates with attention performance for many years and neurofeedback therapists have been using it as a marker in their assessments. What's new is the FDA approval, which is given on the basis of the manufacturer collecting and submitting data - an expensive process.

If ADHD is actually measurable in brain activity, why isn't it the norm to base diagnosis on brain assessment? Well, the connection isn't hard and fast. Not all people with ADHD have a high theta to beta ratio, and not everyone with a high theta to beta ratio has ADHD. (Actually in EEG there are other subtypes of ADHD, such as frontal alpha type.)

Can we say that a high theta to beta ratio is a cause of ADHD? Not really, it might be more of an effect. Or it might be better to describe it as a mediator, meaning a more immediate cause. We then need to ask, what are the primary causes?

It's a controversial question - almost certainly there are a number of causal factors, and not necessarily the same ones in different individuals. See for example the wikipedia ADHD page.

Examples of common causal factors are:

  • Heavy metal toxicity - lead and mercury for example cause brain problems. We're all exposed to toxic metals these days. Some people just don't deal with them very well (perhaps for genetic reasons).
  • Candida overgrowth in the gut.

Not everyone with ADHD will have these, of course.

What's the best way to work with ADHD? I believe, try to find the causal factors applying in any individual case, and address them. That means objective measurements, of a range of things, including the above two, and including EEG.

Currently this is not what happens in the UK's NHS. You're likely to get drug treatment such as ritalin, which if it works at all, will only suppress symptoms. It is not an attempt to fix causes. It's like pumping up a tyre with a puncture.

A rationale for neurofeedback therapy would be to train the brain to produce less theta and more beta, thus reducing the theta to beta ratio. That would make sense rationally, for cases where assessment reveals a high ratio. And there's a lot of evidence it actually works. See for example this ISNR report on neurofeedback for ADHD.

Neurofeedback isn't necessarily going to affect toxic metal levels or candida over-growth. It's probably best used as part of a multi-level integrative or holistic approach. Heavy metals and candida are more directly addressed by nutritional therapy.

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